Quality of life and cognitive function improved with lactulose.
Minimal hepatic encephalopathy (MHE) is subtle cognitive or psychomotor dysfunction in patients with cirrhosis whose mental status seems normal. This study from India examined the effect of lactulose on MHE.
Researchers identified 61 patients with cirrhosis who had no history of overt hepatic encephalopathy but were considered to have MHE, based on abnormalities on at least two neuropsychological tests (from a battery of 6 tests). These patients were randomized to receive 3 months of lactulose or no lactulose; treatment assignment was not blinded. The lactulose group experienced a significant decrease in the mean number of abnormal neuropsychological test results (from 2.74 at baseline to 0.75 at 3 months), but no change occurred in the untreated group. Health-related quality-of-life scores also improved significantly among lactulose recipients, but not among untreated controls.
Comment: In this study, lactulose therapy improved cognitive function and quality of life among patients with minimal hepatic encephalopathy. Although a recent systematic review questioned the efficacy of lactulose for hepatic encephalopathy (Journal Watch Jun 29 2004), editorialists are impressed by the current findings. They speculate that this study "may potentially change the overall management of hepatic encephalopathy," but they call for a larger trial with placebo controls. Another important question is whether there are simpler ways to identify MHE in routine practice.
— Allan S. Brett, MD
Published in Journal Watch General Medicine March 27, 2007